How Did Rural Residents Fare on the Health Insurance Marketplaces?

One of the ongoing questions about the Affordable Care Act (ACA) is its impact on rural areas, many of which had lacked a competitive individual market for health insurance. Would the ACA foster competition among plans in these areas? Or would they be dominated by one or two insurers and face higher premiums and fewer plan choices than their urban counterparts?

This data brief examines 2014 premiums, issuers, and plans offered to residents of urban and rural counties. In 2014, while it appears that residents of rural counties, as a whole, did not face higher premiums than residents of urban counties, substantial differences emerge within a number of states and between states of varying degrees of rurality. In particular, states with largely rural populations face fewer choices and higher premiums. These are the states to watch in the coming months as new issuers enter the marketplaces and 2015 premiums are filed.

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Reform by the Numbers